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Smallpox, seatbelts and smoking: 3 ways public health has saved lives from history to the modern day – The Conversation AU
The coronovirus outbreak has reminded us of the importance of public health responses in managing the spread of disease.
But what actually is public health? And why are we so often hearing from public health experts about the coronavirus and other health threats?
In broad terms, whereas medicine primarily focuses on treating disease in individuals, public health focuses on preventing disease and improving health in communities.
Public health activities are far-reaching and varied. They include health promotion campaigns, infectious disease surveillance and control (as in the response to coronavirus), ensuring access to clean air, water and safe food, screening for disease, community health interventions and policy and planning activities.
Here are three examples which show the important role public health plays.
Read more: It's now a matter of when, not if, for Australia. This is how we're preparing for a jump in coronavirus cases
The development of vaccines to protect against infectious diseases is one of the most significant achievements in both medicine and public health. Vaccines have prevented literally millions of deaths the World Health Organisation (WHO) estimates at least ten million globally between 2010 and 2015 and spared countless others from getting sick.
We now rarely see diseases such as polio, measles and mumps in the developed world thanks to the effectiveness of vaccines. The fact we can protect individuals and communities against some of the deadliest diseases by a simple and safe injection is one of the miracles of modern medicine.
The delivery of vaccines to communities throughout the world and the reduction in disease as a result of this is a testament to public health and its power.
Perhaps the greatest example of the effect vaccines have had on the health of populations globally is the eradication of smallpox. A viral disease characterised by fever and a pustular rash, smallpox was one of the most devastating infectious diseases weve ever seen. It killed around 300 million people in the 20th century alone.
To eradicate smallpox, public health physicians sought to identify new cases swiftly. Then people the cases had come into contact with were vaccinated as quickly as possible to prevent the disease spreading further, a public health measure called ring vaccination. This campaign began in earnest in 1967, with the WHO declaring smallpox eradicated in 1980, in whats regarded as one of the greatest public health achievements of modern times.
Read more: Health Check: which vaccinations should I get as an adult?
Although theres still a lot of work to do, smoking rates have declined over recent decades, with great benefits to our health.
When science established a clear link between smoking and poor health outcomes, the role of public health was to get this message out to the public and implement measures to minimise smoking rates.
Weve managed to reduce deaths due to tobacco through interventions such as health promotion campaigns providing information to the public about the dangers of smoking, restrictions on cigarette advertising, plain packaging, restrictions on smoking in public places, increased taxes on cigarettes, as well as increased access to cessation programs.
Tobacco control is one of the major achievements of public health. This is especially true as weve often had to fight against the industry, or big tobacco, to get these initiatives off the ground.
Read more: Can we trust Big Tobacco to promote public health?
Tobacco control is also a great example of how coordinated actions from a number of different government sectors can be targeted to address a major public health challenge.
Australia has been recognised as a world leader in this area.
Motor vehicles have been a great advancement in modern society, but have also been a major cause of injury and death.
Road deaths in industrialised countries have declined significantly in the last few decades. This reduction has occurred despite the increased number of drivers and distances travelled on the roads in this period.
Weve been able to achieve these safety improvements and therefore reductions in deaths with the help of a wide variety of interventions.
For example, increased regulation in motor vehicle design standards, improved roads, seatbelt regulation, speed limits, drink driving deterrents and the education of drivers.
Despite the gains made, road traffic accidents remain a leading cause of death worldwide, and are a particular problem for developing countries. So theres still much work to be done in this area.
Read more: A new approach to cut death toll of young people in road accidents
Public health has played a major role in the increased health and longevity we take for granted in the modern world. But its perhaps an area we dont give much thought to.
One of the reasons public health gains may be under-appreciated is that they are marked by the absence of disease, which can often go unrecognised. For example, while its clear when a life has been saved by a medical intervention, its much less obvious when disease has been prevented.
This transcript has been edited for clarity.
Hello. I am Alexandra Vinograd. I am an attending physician in the Division of Emergency Medicine at the Children's Hospital of Philadelphia and an assistant professor at the University of Pennsylvania Perelman School of Medicine.
Establishing intravenous (IV) access is a common but challenging procedure in pediatrics. Difficulty in placing an IV can lead to treatment delays, diagnostic delays, pain for the patient, and anxiety for the family members watching their child undergo multiple IV sticks. Point-of-care ultrasound has become routine, particularly for invasive procedures in the emergency department.
We conducted a study that examined whether ultrasound-guided peripheral IV access would improve the first-attempt success rate when compared with traditional IV access in children. We enrolled 167 patients with presumed difficult IV access, based on a previously validated scoring system. We randomly assigned patients to receive ultrasound-guided IV access or traditional IV access. First-attempt success was nearly twice as high in the ultrasound-guided IV group than in the traditional IV access group85.4% vs 45.8%. In addition, there were, overall, fewer attempts in the ultrasound-guided IV group than in the traditional IV access group.
Because it takes time to locate and set up the ultrasound, we were concerned that this procedure could cause delays in time to IV placement. In fact, the opposite was true. For children who received an ultrasound-guided IV, the time from randomization into the study to IV flush was 14 minutes; in the children in the peripheral IV access group, the time from randomization to IV flush was 28 minutes.
We were also concerned about how long the IVs would last. In adults, studies show that 32% of ultrasound-guided IVs may fail within 48 hours of insertion. This would mean that the children would require multiple sticks again to replace IVs that no longer worked. In our study, however, the ultrasound-guided IVs lasted much longer than the traditionally inserted IVs; we found no difference in the type or number of complications in either group.
In adults, vessel depth and the location of the IVs have been shown to affect how long they last. IVs placed in shallower vessels and in the antecubital area or the forearm are more likely to last longer than those placed in the upper arm. In our study, 93% of the ultrasound-guided IVs were placed in the forearm. We also used longer IV catheters, most commonly the 48-mm, 22-gauge catheters or the longer 20-gauge catheters. This probably meant that more of the IV catheter was seated in the vein, promoting a longer survival of that IV.
In our study, the ultrasound-guided IVs were placed by a dynamic technique wherein the provider took the transverse probe, located the vessel on the patient's forearm, identified that it was a vein and that it was not pulsatile, and that they were able to track it forward easily so they would be able to place the IV. The provider then took the catheter, typically a longer catheter, entered the skin at a 45-degree angle, identified the tip of the IV [it appears as a white dot at the top of the ultrasound screen], advanced the probe, and then advanced the ultrasound, each time making sure to advance the tip of the needle into view.
They continued until they entered the vein. Then they flattened out the catheter and continued tracking inside the vessel until the entire IV was seated in the vein.
In this study, attending physicians, fellows, and nurses placed the ultrasound-guided IVs. The three nurses who enrolled patients had a 91% first-attempt success rate. We have continued to train nurses in our department to place ultrasound-guided IVs. It has become standard of care at our institution to use ultrasound-guided placement in children with difficult IV access.
On the basis of our study results, showing a decreased number of first attempts at sticks and overall a lower number of IV sticks, decreased time to IV placement, and increased longevity without increasing complications or the type of complications in children with ultrasound-guided IVs, we believe that ultrasound-guided IV access should be standard of care for children presenting to the emergency department with presumed difficult IV access.
Alexandra M. Vinograd, MD, MSHP, DTM&H, is an attending physician in the emergency department at Children's Hospital of Philadelphia. She was lead investigator of the recent study examining first-attempt success, longevity, and complication rates of ultrasound-guided peripheral intravenous catheters in children, discussed in this commentary.
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Ultrasound-Guided IVs in Kids: How and Why - Medscape
Differences in health policy weren't the only bones presidential candidates had to pick last week. They also sparred over details of their personal health. And with the next debate and Super Tuesday primaries fast approaching, these skirmishes are likely to escalate.
In the run-up to the Las Vegas Democratic presidential primary face-off, Vermont Sen. Bernie Sanders' national press secretary, Briahna Joy Gray, told CNN that opponents are trying to use his October heart attack against him. Then she mistakenly claimed that Mike Bloomberg "has suffered heart attacks in the past" a statement she quickly walked back after a Bloomberg adviser said in a tweet it was a "Trumpy lie."
He did not have a heart attack, Bloomberg's camp explained, trying to differentiate its candidate's health status. He had stents. The former New York mayor, according to the campaign, had coronary stents inserted two decades ago after a cardiac test indicated they might be useful.
Feathers still ruffled, the two candidates went at it again on the debate stage.
"I think the one area, maybe, that Mayor Bloomberg and I share, you have two stents, as well," Sanders said Thursday to his rival onstage.
Bloomberg responded, "Twenty-five years ago."
It's not surprising, with the oldest crop ever of presidential candidates, that their vital signs are becoming a talking point.
"When it comes to politics, personal health is just one more issue to try and leverage," said Arthur Caplan, a professor of bioethics at NYU School of Medicine in New York City.
That got us wondering how this information fits into the facts voters weigh. And in evaluating a candidate's long-term health or electability, does it really matter whether a patient got a stent as part of treatment for a heart attack, like Sanders, or for another reason, such as to relieve chest pain or following a cardiac stress test, like Bloomberg?
"In this day and age, with the way technology has advanced and the skill sets of the cardiologists, I would say they are practically the same. We expect good results for both," said Dr. Hadley Wilson, a practicing cardiologist in Charlotte, North Carolina, and a member of the American College of Cardiology's board of trustees.
Stents are almost always used when a person is having a heart attack.
Heart attacks can occur when plaque breaks off inside the blood vessels of the heart, causing a blockage. To open the blocked artery, physicians insert stents, which are small, wire-mesh tubes. Afterward, patients are treated with medications to reduce the risk of subsequent heart attacks.
Back when Bloomberg got his, they were commonly used in nonemergency situations to prop open narrowing arteries, with the thought that might prevent a heart attack, said Dr. Suzanne Steinbaum, a cardiologist in New York and a spokesperson for the American Heart Association.
But, since then, "we learned stents don't prevent a heart attack and that using medication might be equally beneficial," Steinbaum said, adding that the best preventive measures are lifestyle choices, such as eating a good diet, exercising and not smoking. Patients still sometimes get stents to alleviate symptoms, such as chest pain, or for other reasons.
Thursday's debate also highlighted the broader question: Just how much of a candidate's medical history is fair game for public consumption?
Sanders, who faced criticism in October for delays in reporting his condition, said he has since released "the full report of that heart attack" including letters from his primary care doctor and two cardiologists attesting to his overall health and recovery.
But candidate Pete Buttigieg, the former mayor of South Bend, Indiana, said Sanders had not provided enough detail and neither, he said, had the others.
"Under President Obama, the standard was that the president would release full medical records, do a physical and release the readout," he said during the debate. "Now, President Trump lowered that standard. He said just a letter from a doctor is enough. And a lot of folks on this stage are now saying that's enough."
Buttigieg himself has yet to provide a full medical record.
"But I am certainly prepared to get a physical, put out the results," he said during the debate. "I think everybody here should be willing to do the same."
Some observers agree there's no such thing as TMI (too much information) when it comes to POTUS (the president of the United States).
"When the country is hiring someone to have their finger on the nuclear button, the expectation of personal privacy is very, very limited," said David Blumenthal, head of the Commonwealth Fund and co-author of "The Heart of Power: Health and Politics in the Oval Office." "It's hard to imagine something [health-related] that would not be relevant."
That argument, though, doesn't always hold up.
When he ran for president in 2008, the then-70-year-old Sen. John McCain released more than 1,000 pages of his medical records.
By contrast, the campaigning Donald Trump initially released a glowing letter from his personal physician that concluded he would be "the healthiest individual ever elected to the presidency." After criticism that the letter lacked specifics, Trump added information on his height, weight and cholesterol levels and went on to become the oldest president, at age 70, to take office, beating out Ronald Reagan, who was just weeks shy of that milestone on Inauguration Day in 1981.
This year, candidates Bloomberg and Sanders are both 78; former Vice President Joe Biden, 77; and Sen. Elizabeth Warren, 70. Sen. Amy Klobuchar is 59, and Buttigieg is the youngest, at 38.
Anything that might be "relevant to a candidate's ability and competence to govern and their longevity of service" should be disclosed, said Blumenthal, who is also a medical doctor.
Voters could then decide what they thought was important. The information might also affect how voters view the choice of a vice president, especially if the candidate for the highest office had a serious illness or something else that might limit their term, he said.
Specifically which records, though, and how to release them is a complicated issue.
Caplan, at NYU, has long advocated setting up a special independent medical panel to evaluate presidential candidates' health and make their findings public.
"It would be like an executive physical, which is what a lot of companies do before they pick a CEO," he said.
And deciding what to test for would be, in itself, complicated. Without a special panel which, even Caplan admits, would meet political inertia the challenges would be numerous. Even locating all the necessary records would be difficult.
The candidates "may have moved around the country, their doctors may have died, or records may not be available," noted Lawrence Altman, who covered many presidential elections as a reporter for The New York Times and is now a global scholar at the Woodrow Wilson International Center for Scholars.
While there is no specific requirement that candidates release any information at all, what readers and voters want to know varies widely.
"It depends on their interest in the candidate," Altman said. "A lot of people superimpose their political choices or feelings on the medical aspect. They are willing to dismiss something if they really like the candidate or make a big issue about it if they don't like the candidate."
(Editors note: This article is part of an editorial partnership between Next Avenue and The American Federation for Aging Research (AFAR), a national nonprofit whose mission is to support and advance healthy aging through biomedical research.)
Are you as old as you feel, as old as you look or as old as your birth certificate says? The best answer may be none of the above.
Actually, you may be as biologically old as your blood says you are.
For many years, aging researchers have sought markers of biological age, or biomarkers simple signals that reveal the expected length of your future health. The expected length of future health, after all, is the key biological difference between younger and older people.
Some people have called such markers biological clocks. I dont know about you, but I dont typically calculate my age by thinking of clocks. I think of calendars. So, I prefer to call these hypothetical signals biological calendars.
The importance of these calendars is that they potentially allow researchers to quickly see whether a new drug, diet or other treatment that purports to slow, or even possibly reverse, aging is actually doing so.
Biological calendars of aging can also provide rapid feedback on how a lifestyle change, such as in diet or exercise habits, is affecting your biological age. This insight can motivate people to stick with that change.
Now, as a biological calendar, blood is a devilishly complex stew. Like a stew, it is liquid with lumps in it. We call the liquid plasma; the lumps, cells. Physicians for the past century have been using chemical analysis of plasma and counts of the various blood cell types to diagnose diseases. But we are now entering a brave new world of blood analysis.
Plasma contains not just the dozen or two chemicals that standard laboratory tests measure; it contains a constantly changing mixture of vitamins, nutrients, waste products, hormones and thousands of different proteins.
A hint that plasma might hold secrets about aging has come from research in which the plasma from young mice (or humans!) was found to rejuvenate the function of muscles, brain, heart and other organs of old mice. Dracula, it turns out, may have been onto something.
Recent advances in chemical analysis allow us to measure thousands of plasma chemicals at once, and advances in machine learning are helping make sense of that torrent of information. Plasma proteins may turn out to be just the type of biological calendar we are seeking.
I say this because a recent study of about 3,000 plasma proteins found that a specific combination of 373 of these proteins could accurately tell the age of the person from whom it was drawn. The study was conducted by AFAR Scientific Director Dr. Nir Barzilai with AFAR grantees David Gate of Stanford University and Dr. Sofiya Milman and Dr. Joe Verghese, both from the Albert Einstein College of Medicine in New York.
On top of that, people who were judged by their proteins to be younger than their real age scored better on a panel of physical and mental tests. We dont know yet how well these proteins might predict future health or life, but those studies will soon follow.
Blood cells, in addition to plasma, might have an even more promising aging tale to tell.
Your white blood cells (but not your red cells) contain your DNA, which provides the instruction manual for pretty much everything that goes on in your body. A few years ago, it was hoped that telomeres those protective DNA caps at the ends of your chromosomes from white blood cells might be a useful biological calendar. But telomeres as predictors of future health have not held up to scientific scrutiny.
However, we may have just been looking at the wrong part of our DNA.
Although we tend to think of DNA as little more than a long-coded sequence of DNA letters, there is a bit more to it. In particular, there are a number of small chemical tags that attach to DNA at specific sites to help turn off, or turn on, genes.
In recent years, combinations of particular tags called DNA methylation have, like plasma proteins, been shown to be good predictors of age and health in people and animals. These tags have even been shown to predict time to death and the development of later life diseases in people.
Perhaps even more exciting, a small, very preliminary study of 10 middle-aged men taking a hormone cocktail designed to stimulate the immune system showed a one-and-a-half-year regression in their DNA methylation calendar.
Lets not get too excited about this result yet. It is easy to overinterpret such very preliminary results, as some of the media have done. We have no idea at present what a small backward trend in DNA methylation age means, and this study has more than a few limitations. But it is without doubt provocative.
Stay tuned. Analysis of blood cells and blood plasma may hold secrets of aging that we are just beginning to discover.
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Does our blood hold the secrets of our longevity? - The Oakland Press
A new fad diet making the rounds on wellness influencer Instagram won't actually help you lose weight. And it could cause dehydration, urinary tract infections, kidney stones, organ failure - even death.
It's called "dry fasting." It goes beyond what most of us would consider fasting - abstaining from solid food or liquid calories - and requires consuming no water or liquids of any kind for many hours or even days at a time.
Instagram and other social media sites have provided a glossy new platform for extremely dubious health and nutrition claims. Posts about dry fasting often tout the need to "heal" or "rest" or "reset" your kidneys, or "boost" their filtration. In practice, what dry fasting will do is make you look a bit more toned, because your body is using up the water in your cells for energy.
Even more dubious claims suggest that dry fasting forces your body to burn toxins, or fat, or inflammation, or tumors. It does not. When you stop feeding your body calories, it breaks down muscle and fat. The toxic byproducts of that breakdown process build up in your system, requiring extra hydration to flush them out.
In other words, if you're abstaining from food, your body needs more water, not less.
Experts agree: There is no dietary or nutritional reason to go on a "dry fast."
"I don't recommend it at all," said Dr. Pauline Yi, a physician at UCLA Health Beverly Hills who regularly treats patients in their late teens and early 20s. She said intermittent fasting and other fasting-type diets are a popular topic with patients, and she has no problem with people trying them out.
"But I also tell them when you're fasting you have to drink water," she said. "You cannot go without hydration."
The majority of the human body is water. Your individual water consumption needs depend on your height, weight, health and the climate, but generally speaking, Yi said people should be consuming at least 68 ounces - almost nine cups - of water every day.
Cary Kreutzer, an associate professor at USC's schools of gerontology and medicine whose area of expertise includes nutrition and diet, says digestive systems aren't meant to have extended "breaks." She likened making your kidneys go without water to letting your car's engine run out of oil. "You can basically burn out some parts of the car that you're going to have to get replaced," she said. "You don't want those replacement parts to include your vital organs."
Another unintended consequence of dry fasting: It sets your body in water-conservation mode.
"Your body likes homeostasis," said Yi, the physician. "If you're going to cut back on water, your body will produce hormones and chemicals to hold onto any water."
So while you might gain a very short-term benefit by looking a tiny bit more toned while you're severely dehydrated (body-builders have been known to dry fast before competitions for that reason), once you consume liquid again, your body rebounds and desperately hangs on to even more water than before. It's like yo-yo dieting in fast motion.
Dry fasting is not the same thing as intermittent fasting, which has become a popular fad diet in recent years. There are different variations of intermittent fasting, but most people start with 16 hours of fasting followed by eight hours of eating. Martin Berkhan created the "LeanGains" 16:8 intermittent fasting guide and is widely credited with popularizing the diet. On his website, leangains.com, Berkhan writes that during the 16-hour fasting window, coffee, calorie-free sweeteners, diet soda, sugar-free gum and up to a teaspoon of milk in a cup of coffee won't break the fast.
The subreddit for fasting, r/fasting, has an "Introduction to Intermittent Fasting" guide that contains the following tips for surviving the fasting portion of your day:
Always carry water, a canteen, a bottle, or keep a full glass within sight
Water, water, water, water
Valter Longo has studied starvation, fasting and calorie restriction in humans for nearly 30 years. He's currently the director of the Longevity Institute at USC and a professor of gerontology. He developed the Fasting-Mimicking Diet, or FMD, a fasting-type diet with small prepackaged meals intended to provide the health and longevity benefits of a five-day fast without requiring a doctor's supervision. Fasting-type diets have grown in popularity in recent years for a simple reason, he said: "Because they work."
But he said he's not aware of any reputable studies about the effects of dry fasting, and said he wouldn't even consider putting one together, also for a simple reason: It's incredibly dangerous.
"For sure, the body needs to reset, but there are safe ways of doing that, and dry fasting is not one of them," Longo said. "We require water."
His work has also involved looking at how cultures and religions have engaged with starvation and fasting throughout human history, and says he hasn't heard of any that involved extended fasting without water. The closest is Ramadan, during which observers go without food or water during daylight hours - but at most, that lasts for 16 hours, and it's preceded and followed by extensive hydration.
If someone tries dry fasting for a full day, Longo said, they risk side effects like developing kidney stones. Longer than that, and you start risking your life.
Some proponents of "dry fasting" eschew water but recommend hydrating with fresh fruits and vegetables. Hydrating with fruit is certainly better than not hydrating at all. An orange has about a half-cup of water in it; to get to the recommended 68 ounces of water a day, you'd have to eat around 17 oranges. That's a lot of peeling.
So, in conclusion: Dry fasting puts you at risk of kidney stones or organ failure. There are no known, proven long-term benefits to doing it. Though different types of fasts and fasting diets can be beneficial, there is no medical evidence to suggest you need to stop consuming water for any period of time, or that water from fruit is better for you than filtered drinking water. Do not take medical advice from a photo of a person in a sarong.
(c)2020 Los Angeles Times
Distributed by Tribune Content Agency, LLC.
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What 'dry fasting' is and why you shouldn't do it - PostBulletin.com
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Picture this: Youre waiting in the checkout line at the grocery store when suddenly you open your ears to the music playing overhead. Its You Belong With Me by Taylor Swift. You know, that song you pretend to hate but secretly love? Anyway, in the middle of trying not to sing along too loudly, you notice Taylor does this thing with the melody. You cant quite put your tongue on what it is, but youve heard it before. You shrug and move on because its your turn to check out.
That is, unless youre musicologist Nate Sloan and songwriter Charlie Harding, whose podcast, Switched on Pop, is devoted to diving into pop music. They seek to answer questions like these: What rhythms make us dance? Why is Max Martin so good at making pop jams? Whats that underwater sound so many songs have been featuring lately? And, of course, what is that THING Taylor Swift does in so many of her songs?
If you ask Sloan and Harding, its a trio of descending notes called a T Drop, and its just one of the many pop-music moments they use to explain different musical concepts in their new book, Switched on Pop: How Popular Music Works, and Why It Matters.
The duo started the podcast in October 2014 and are at 146 episodes and counting. About two years ago, they decided to take their shared interest in music composition and pop music one step further with a book.
Harding said its not that there was a real need for a text, but their listeners kept writing them saying they wished there was a book to help understand core musical concepts.
The book is the most fun music theory class you could ever take, Sloan said.
They wanted to give people an essential guide with pop songs as examples, Harding said, but as one can imagine, choosing which songs to include was not exactly an easy task. They tried to narrow their list down by only choosing songs from the last 20 years ones readers have likely heard before. Hey Ya! by Outkast, Despacito by Luis Fonsi and Daddy Yankee and Oops! I Did It Again by Britney Spears are just a few of the megahits that made the book.
Sloan said the selection process was long, but fun. They wanted to choose songs that had a sense of longevity, which can be hard to predict, he said.
We had such a long conversation about whether Justin Bieber should be in the book, Sloan said.
In addition to educating readers and listeners on musical concepts, the authors started the podcast to share their passion for music composition. They wanted to connect with people around musical conversations, which isnt as easy as you would think for pop. In the books introduction, Sloan and Harding admit to once being music snobs who let their feelings toward the genre prevent them from enjoying it.
Theres so much (pop) has to teach us about our own internal biases, Harding said.
The podcast may be called Switched on Pop, but their purpose is also to help people become switched-on listeners, Harding explained.
Its OK to embrace your taste, he said. Be into what youre into.
Through the podcast, theyve also provided music education to people who may not be able to access it easily. Sloan said theyve gotten emails from educators who have used the show as a learning tool. He said, in a way, pop music was the spoonful of sugar that helped the music-theory medicine go down but then it became the medicine itself.